Principles of management of hand fractures

Abstract

The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.

Keywords: Fracture fixation; Hand therapy; Metacarpal fractures; Pain management; Phalangeal fractures; Splint.

Figure 1

The anatomical position of the scaphoid tubercle, as illustrated by orientation of the digits of a normal hand

Figure 2

Examination of the sensory nerve supply of the hand, based on Thai et al (2015) The dots represent the discrete testing points for each nerve

Figure 3

Preoperative AP (a) and lateral (b) views of a proximal phalangeal fracture of the ring finger managed with Kirshner wire stabilisation. Intraoperative AP (c) and lateral views (d) are also shown

Figure 4

AP (a) and oblique (b) views of a fifth metacarpal fracture managed with screw fixation. Postoperative imaging with screws is shown including AP (c), oblique (d) and lateral (e) views

Figure 5

Preoperative AP (a) and lateral (b) views of proximal interphalangeal fracture of thumb managed with screws, plating and splinting. Postoperative AP (c) and lateral (d) views are also shown